Mountain Diabetes and Endocrine Center, Asheville, North Carolina 28803, USA.
Diabetes Technol Ther. 2011 May;13(5):592-5. doi: 10.1089/dia.2010.0221. Epub 2011 Mar 15.
Patients with insulin-treated type 2 diabetes and high insulin requirements are subject to undesirable treatment-related weight gain. These patients would potentially benefit from the insulin-sparing and weight loss benefits of glucagon-like peptide 1 (GLP-1) receptor agonist therapy; however, GLP-1 receptor agonists currently are not approved for use in combination with insulin. We examined the effects of adding liraglutide at a daily dose of 1.2 or 1.8 mg to an intensive regimen (either multiple daily injections or continuous subcutaneous insulin infusion) of U-500 insulin on hemoglobin A1c (HbA1c), total daily insulin dose, and weight in 15 patients with type 2 diabetes and high insulin requirements (initial mean daily insulin dose of 192 ± 77 units per day; initial mean weight, 300.9 ± 55.7 lbs) in a clinical practice setting.
In this observational case series, we identified 15 patients treated with a combination of U-500 insulin and liraglutide for at least 12 weeks at routine follow-up office visits. The U-500 insulin dose was reduced by 0-30% upon initiation of liraglutide. Insulin doses were subsequently adjusted to optimize glycemic control. Endpoints included change in HbA1c, change in total daily insulin dose, change in weight, and incidence of hypoglycemia. Comparisons of 12-week and baseline values were evaluated by paired two-tailed t tests.
At 12 weeks, the reduction in HbA1c from baseline (8.48%) was 1.4% (P = 0.0001). Weight fell by an average of 11.2 LB (5.1 KG) (P = 0.0001). Total daily insulin dose was reduced by 28% (P = 0.0001). No severe episodes of hypoglycemia occurred.
Adding liraglutide to U-500 insulin resulted in significant improvements in glycemic control, weight loss, and reduced insulin requirements in patients with type 2 diabetes and high insulin requirements.
接受胰岛素治疗的 2 型糖尿病患者和胰岛素需求较高的患者会出现不良的治疗相关体重增加。这些患者可能会受益于胰高血糖素样肽 1（GLP-1）受体激动剂治疗的胰岛素节省和体重减轻益处；然而，GLP-1 受体激动剂目前尚未获准与胰岛素联合使用。我们研究了将利拉鲁肽以 1.2 或 1.8mg 的每日剂量添加到 U-500 胰岛素强化治疗方案（每日多次注射或持续皮下胰岛素输注）中对 15 例 2 型糖尿病和胰岛素需求较高的患者的糖化血红蛋白（HbA1c）、总日胰岛素剂量和体重的影响，这些患者在临床实践环境中接受 U-500 胰岛素和利拉鲁肽联合治疗至少 12 周。
在这项观察性病例系列研究中，我们在常规随访门诊中确定了 15 例接受 U-500 胰岛素和利拉鲁肽联合治疗至少 12 周的患者。在开始使用利拉鲁肽时，U-500 胰岛素剂量减少 0-30%。随后调整胰岛素剂量以优化血糖控制。终点包括 HbA1c 的变化、总日胰岛素剂量的变化、体重的变化和低血糖的发生。通过配对双侧 t 检验评估 12 周和基线值的比较。
12 周时，HbA1c 从基线（8.48%）降低了 1.4%（P=0.0001）。体重平均下降 11.2 磅（5.1 公斤）（P=0.0001）。总日胰岛素剂量减少了 28%（P=0.0001）。没有发生严重的低血糖事件。
在 2 型糖尿病和胰岛素需求较高的患者中，将利拉鲁肽添加到 U-500 胰岛素中可显著改善血糖控制、体重减轻和减少胰岛素需求。
